This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Sudden onset flash pulmonary edema (PE) is a significant co-morbidity of patients with underlying hypertension, diabetes, and coronary artery disease. We will study those at high risk for PE which an identifiable cause has not been established. After testing, we will follow our participants over time to ascertain the post-testing outcome of the occurrence of flash PE warranting hospitalization. Our design will allow us to determine if change in aortic stiffness during dobutamine independently predicts flash PE after controlling for other factors that promote PE (e.g., age, LV hypertrophy, or increased aortic wall thickening). In addition, our study design will allow us to determine if change in aortic stiffness during intravenous dobutamine is an independent predictor of flash PE after controlling for its effect on LV stroke volume reserve (stress/rest ratio of LV stroke volume). Our results will be significant in that we will define the relationship between factors affecting aortic stiffness and LV performance, and the future occurrence of flash PE warranting hospitalization. With this understanding, we will gain mechanistic insight into the pathophysiology of flash PE that will be useful for developing interventions to prevent the morbidity and mortality associated with this disorder.